Re-Occupancy Application REOCC-11-22-2835f-
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RE -OCCUPANCY
APPLICATION
Contact Name:
Miami Shores Village aEcErvE]D
Building Department NOV (;4 022
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
14 P��10-om 6
Permit No. k8ocC H—
3U S 3 l L S/%o3
Buyer: Seller: lei V li1��!Z�DiyJ C7
Realtor: Company Name: 60M,60N I/IWLITMOy?S-CMJ
Property Address: 10q c? tie �� �' �f ) ��21,0M1 d Ndo ,, J
City: Miami Shores State: Florida Zip:
I hereby certify that I understand that the zoning for this property is for single-family residential use and that it
is unlawful for more than one family to reside therein. I also understand that any Certificate of Re -Occupancy
that may be issued by Miami Shores Village certifies only that the referenced property is being used for single
family purposes and that such certificate does not constitute any representation, warranty or certification as to
the condition of the dwelling or other structures on the property.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
Applicant
Signature:
The foregoing instr�nt was acknowwlleec gedd, eef�oorre% �m1 ee this
dayof NOV 20' �I O t 'fd Ql7 fQ
who is personally known to me or who has produced 1 r
cwAs identification and who did take an oath
NOTARY PUBLIC:
Sign: �r/I
Print: 1 �r nI-rA I(i' lY
My Commission Expires.
Building Officials Appro
REV 4-10
MERUNECHERY
MY COMMISSION # HH 252206
EXPIRES: April 1Z 2026
Re-Occ 560.00 om
Notary
Total $